In a joint letter to health secretary Wes Streeting, the unions warn that the pay award fails to keep pace with the cost of living, will not repair years of lost pay and does not address lower rises for those on Agenda for Change contracts than other groups. 

Staff are angry and feel deeply let down after years of falling wages and relentless pressure, say the 14 unions representing more than a million health workers.

They point out that by relying on the discredited NHS Pay Review Body process rather than negotiating directly with unions, ministers have wasted an opportunity to deal with headline pay awards and much-needed reform of the pay structure at the same time through comprehensive talks.

The 2026/27 headline rise will be imposed on 1 April, with negotiations to follow on structural fixes, which would mean additional rises for some staff if a deal is reached.

However, the unions say those talks were promised more than 18 months ago, and the ongoing delay has wrecked trust.

The letter says: 'Day in, day out staff are battling understaffing, overwork and the constant worry that – despite their best efforts – patients are not getting the care they deserve.

'To rebuild confidence, negotiations must now move quickly and show clearly how they will improve on what staff have already been offered.'

The government must provide sufficient funding to make sure talks succeed, unions add.

Despite the anger over pay, workers say they remain committed to the future of the health service.

'No one wants the NHS to succeed more than the staff who keep it running. But that requires a workforce that is properly valued and properly paid.'

The unions are also asking health workers to sign an online version of the letter to demonstrate the strength of feeling.

Helga Pile, chair of the NHS unions and Unison head of health, said: 'For most NHS staff this will feel like a pay cut not a wage rise. After years of rising pressure and falling wages, health workers expected better from this government. If ministers really want the NHS to recover, they have to start by valuing the staff who keep it going.

'There's a lot riding on these talks. Real money on the table from government will be key.'

Secretary to the NHS unions and assistant director of the Chartered Society of Physiotherapy, Jim Fahie, added: 'The letter is a way for NHS staff to make their voices heard and show ministers that they need to do more on pay.

'It's important that as we enter negotiations over the pay structure, ministers and civil servants know that it remains an issue of high importance to the brilliant staff who have kept the NHS afloat under enormously difficult circumstances in recent years.'

The letter is co-signed by ALM, BAOT, BDA, BOSTU, CSP, GMB, PDA, POA, RCN, RCM, RCPod, SOR, Unison and Unite.